Selective cauterization of supporting ligaments at Non Descent Vaginal Hysterectomy (NDVH)

Abstract

INTRODUCTIONHysterectomy is a most commonly performed gynaecological operation. Abdominal and laparoscopic route of hysterectomy are associated with higher costs. 1 Most hysterectomies can be completed with vaginal route. However currently only 25-30 percent of them performed vaginally.2 It is a well-established fact that vaginal hysterectomy has less complications and a better post-operative out outcome.3-5 Purohit R has devised a technique where all stumps are secured by means of electrocautery.6 Sheth S has suggested that NDVH can be in done all situations like previous caesarean section and larger uteri. 7 We slightly modified this technique and used electrocautery only for cardinal uterosacral ligament complex. Use of electrocautery for all stumps may cause more charring and tissue destruction. There can be lateral spread of the electrocautery effect and may result in more tissue damage. 8 We selectively used electrocautery for securing cardinal uterosacral ligament complex. We feel division of cardinal uterosacral ligament complex is the most difficult step in vaginal hysterectomy. Once this is done NDVH becomes easier. We present a new technique where in only uterosacral ligaments are divided after electrocauterization. We have done 21 cases of NDVH using this technique with no complications. METHODSWe did a prospective observational study among patients undergoing NDVH using this new technique. Only cases where uterine size is less than 14 weeks of pregnant uterus entered the study. Before surgery a per speculum examination was done and if cervix was visualized easily they entered the study. Cases where cervix was not easily visualized were excluded from the study. The procedure for hysterectomy consisted of the following• After putting a vaginal speculum, Cervix pulled with a vulsellum. We did not infiltrate saline adrenaline around the cervix • Vaginal walls were incised both anteriorly and posteriorly with small transverse incision • Bladder dissected of the cervix ABSTRACT Background: The objective of the study was to study the use of electrocautery selectively for cardinal uterosacral ligament complex during NDVH. Methods: We performed a series of NDVH where electrocautery was used selectively for the uterosacral cardinal ligament complex. Rest all stumps were clamped, divided and ligated. Results: We did a series of 21 cases using this technique and found this as a very effective method of doing NDVH. There were no major complications. Conclusion: Selective use of electrocautery for uterosacral and cardinal ligament complex makes NDVH easy.